American Medical Compliance

FEBRUARY 15, 2023

The EMS Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. Fraud schemes range from solo ventures to widespread activities of an institution or group.

Fraud 52

Fraud Medicare Medicare Compliance 52

Compliancy Group

APRIL 17, 2024

Office of Inspector General (OIG) in the Department of Health and Human Services (DHHS) oversees efforts in the healthcare sector to identify, reduce, and prevent incidents of fraud, waste, and abuse of funds from programs like Medicare. Medicare Advantage (M.A.): and cybersecurity threats. Organizations using M.A.

Compliance Officers 52

Compliance Officers Compliance Medicare Medicare 52

Provider Trust

MAY 16, 2024

This landmark milestone represents a continued commitment by ProviderTrust and its nearly 1,000 healthcare client organizations to ensure Medicare and Medicaid dollars are protected from fraud, waste, and abuse. Healthcare compliance plays an instrumental role in the success of the entire healthcare ecosystem.

Fraud 52

Fraud Medicaid Medicaid Licensing 52

Compliancy Group

FEBRUARY 7, 2024

This is because the Centers for Medicare & Medicaid Services (CMS) have ramped up their efforts to identify organizations that have improperly billed for medical services. The Centers for Medicare and Medicaid Services (CMS) created UPIC audits to identify and stop fraud and abuse in Medicare and Medicaid.

Fraud 52

Fraud Compliance Medicare Medicare 52

YouCompli

SEPTEMBER 13, 2023

Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. Enforcement agencies are prioritizing efforts to deter FWA as more individuals enroll in government healthcare programs like Medicare and Medicaid, and telehealth services continue to evolve post-pandemic.

US Department of Health and Human Services 52

US Department of Health and Human Services Compliance Officers Compliance Fraud 52

MedTrainer

JULY 28, 2023

Earlier this year, an in-depth OIG investigation resulted in a six-day trial of a former Louisiana health clinic CEO , who was ultimately convicted of Medicaid fraud and sentenced to 82 months in federal prison. Medicare/Medicaid Compliance Reviews. But what exactly is considered fraud, waste, and abuse?

Fraud 98

Fraud Compliance Medicaid Medicaid 98

MedTrainer

JANUARY 30, 2024

Healthcare compliance is a critical part of any organization’s business model. The professionals who manage compliance are the front lines of preventing medical errors, deterring fraud, and staying in good standing with federal payers like the Centers for Medicare and Medicaid Services (CMS).

Compliance 52

Compliance Compliance Officers Fraud Medicaid 52

MedTrainer

JANUARY 10, 2024

Review Recent Compliance Changes There is a major shift in compliance priorities toward addressing health inequities and improving access to quality healthcare services. The OIG is making major investments to systematically detect and prosecute fraud. We all should be a LOT more prepared!

Compliance 94

Compliance Fraud HIPAA Compliance Officers 94

AIHC

MAY 31, 2022

Health care insurance fraud is a pressing problem, causing substantial and increasing costs in medical insurance programs. To combat fraud and abuse, all levels within a medical practice, hospital or health care organization must know how to protect the organization from engaging in abusive practices and violations of civil or criminal laws.

Fraud 52

Fraud Compliance Officers Compliance Medicare 52

MedTrainer

SEPTEMBER 20, 2023

If you want to obtain or retain CMS certification in order to be reimbursed by services provided to patients with a Medicare/Medicaid health plan, you must comply with HIPAA rules and regulations. There are several accrediting organizations that require facilities to meet or exceed Medicaid and Medicare guidelines.

Medicaid 97

Medicaid Medicaid Medicare Medicare 97

Compliancy Group

FEBRUARY 29, 2024

When a hospital, doctor’s office, or other healthcare organization is guilty of a regulatory or compliance violation , the U.S. Office of Inspector General (OIG) can invoke civil or criminal prosecution or licensure or other penalties, fines, exclusions from federal programs like Medicare, or revocation of billing privileges.

Compliance 52

Compliance Compliance Officers Overpayments Overpayment 52

Healthcare Compliance Blog

APRIL 26, 2022

The compliance documents include special fraud alerts, advisory bulletins, podcasts, videos, brochures, and papers providing guidance on compliance with federal healthcare program standards. Toolkits: The OIG has created several toolkits to help providers ensure they are in compliance with healthcare laws.

US Department of Health and Human Services 59

US Department of Health and Human Services Fraud Compliance Medicaid 59

MedTrainer

FEBRUARY 12, 2024

Knowingly or falsely claiming monies from federal programs such as Medicare and Medicaid has cost healthcare entities $72B since 1986. How are healthcare organizations ensuring compliance and minimizing exposure risks to false claims? MedTrainer makes it easy to connect corporate compliance policies to training.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

MedTrainer

JANUARY 12, 2024

Here are some of the key organizations involved in regulating healthcare compliance: Centers for Medicare & Medicaid Services (CMS): CMS is a federal agency within the U.S. Department of Health and Human Services responsible for administering and regulating healthcare programs such as Medicare and Medicaid.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

MedTrainer

JANUARY 30, 2024

Compliance is Mandatory for Federal Programs One constant is that organizations and facilities that participate in federal healthcare programs, such as Medicare and Medicaid, must have a compliance program. Laboratories: Clinical laboratories that perform tests covered by Medicare or Medicaid.

Governance 52

Governance Compliance Nursing Homes Medicaid 52

Innovaare Compliance

AUGUST 31, 2022

Medicare Advantage Organizations (MAOs) are private health plans that contract with the Centers for Medicare & Medicaid Services (CMS) to provide a menu of health care services similar to those offered under Original Medicare. 1 They pay for the services with monthly fixed payments (capitation) from CMS.

Medicare 52

Medicare Medicare Compliance Officers Fraud 52

Compliancy Group

AUGUST 31, 2023

Healthcare compliance laws play a vital role in safeguarding patients’ rights, preventing fraud and abuse, and maintaining the integrity of healthcare systems. Let’s delve into the importance of healthcare compliance laws and regulations, their impact on providers and organizations, and the guidelines governing their implementation.

Compliance 52

Compliance Compliance Officers Fraud Compliance Framework 52

MedTrainer

OCTOBER 23, 2023

Office of Inspector General (OIG): Prevents fraud, waste, and abuse within the department’s vast array of Department of Health and Human Services (HHS) initiatives. Centers for Medicare and Medicaid (CMS) : Evaluates providers’ adherence to state/federal regulations and guidelines at both the individual and organizational levels.

Compliance 52

Compliance Compliance Officers Fraud Governance 52

Provider Trust

JULY 17, 2023

In our recent webinar, ProviderTrust’s Chief Compliance Officer, Donna Thiel, shared her expertise and valuable feedback from the 2023 HCCA Compliance Institute. Watch the Webinar During the Keynote Speech at the HCCA Compliance Institute this year, Office of Inspector General (OIG) Christi A.

Compliance 52

Compliance Nursing Homes Nurses Fraud 52

MedTrainer

FEBRUARY 1, 2024

A corporate compliance program in healthcare is a comprehensive set of policies, procedures, and practices that healthcare organizations establish and maintain to ensure that they operate compliant with all applicable laws, regulations, and ethical standards. Why do healthcare facilities use corporate compliance programs?

Compliance 52

Compliance Fraud Regulatory Compliance Regulations Compliance 52

AIHC

APRIL 5, 2022

Due to the huge volume of claims payers receive to process, deny and pay, they have implemented various methods to track providers to detect potential waste, fraud and/or abuse. If the payer, such as Medicare, performs an extrapolation, reducing each overpayment dollar through appeal can mean thousands less to pay back.

Fraud 52

Fraud Compliance Medicare Medicare 52

Medisys Compliance

JANUARY 30, 2023

Medicare and Medicaid: Medicare and Medicaid are government-funded healthcare programs that provide coverage to millions of Americans. These can include additional privacy and security requirements, as well as laws related to medical billing and coding , fraud and abuse, and other issues.

Compliance 52

Compliance Medical Billing Medical Billing Outsourcing HIPAA 52

YouCompli

DECEMBER 7, 2022

Department of Health and Human Services Office of Inspector General (OIG) has the authority to exclude individuals and entities from federally funded healthcare programs. These exclusions are generally related to criminal activity like fraud or healthcare-related misconduct. Patient abuse or neglect. Check state level lists as well.

Fraud 52

Fraud US Department of Health and Human Services Compliance Medicaid 52

Verisys

MAY 3, 2023

7 Core Elements of Healthcare Compliance Plan and How to Measure Them Healthcare compliance regulations are complex and ever-changing, but are an essential part of any healthcare organization’s effort to provide safe, high-quality care for patients. Measuring effectiveness: Who is your designated compliance officer?

Compliance 52

Compliance Compliance Officers ADA Governance 52

Compliancy Group

FEBRUARY 2, 2024

In the case of healthcare fraud or other forms of noncompliance, the organization at fault could enter a corporate integrity agreement (CIA) with the Office of the Inspector General (OIG). Other outcomes include deferred prosecution under certain conditions, penalties, and continued oversight.

Compliance 52

Compliance Overpayments Overpayment Compliance Officers 52

HIPAA Journal

JANUARY 30, 2023

Government Keynote Speakers Nicholas Heesters, MEng, JD, CIPP – Senior Advisor for Cybersecurity, Office for Civil Rights, US Department of Health and Human Services, Philadelphia, PA Melanie Fontes Rainer, MSME, JD – Director, Office for Civil Rights, HHS; Former Senior Advisor, Healthcare to Attorney General, CA DOJ; Former Chief of Staff, (..)

US Department of Health and Human Services 81

US Department of Health and Human Services HIPAA Compliance Medicaid 81

MedTrainer

OCTOBER 4, 2023

To ensure organizations meet these standards, federal healthcare compliance requirements have been put in place. These regulations and laws help maintain patient confidentiality, ensure quality care, and prevent fraud and abuse within the healthcare industry. Office of Inspector General (OIG).

Compliance 52

Compliance Fraud HIPAA Governance 52

Healthcare Compliance Blog

FEBRUARY 8, 2022

The complaint alleges that an Alabama psychiatrist caused the submission to Medicare and Medicaid of false and fraudulent claims for the prescription drug Nuedexta. From 2015 through 2019, the pharmaceutical company that manufactures Nuedexta paid the Alabama psychiatrist more than $400,000 to make speeches about Nuedexta.

Nursing Homes 52

Nursing Homes Nurses Compliance Medicare 52

MedTrainer

JANUARY 12, 2024

Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation. Compliance in healthcare began to encompass billing, fraud, and abuse prevention. Compliance evolved to include performance reporting and quality metrics.

Compliance 52

Compliance HIPAA Telemedicine ACA 52

Provider Trust

JULY 25, 2022

To eliminate fraud in your health ecosystem, you must stay compliant with federal and state requirements for referring and ordering physicians. Continuous compliance begins with automated monitoring, cross-departmental communication, and population-specific workflow. billion in Medicare charges. Recent OIG Enforcement Actions.

Electronic Medical Records 52

Electronic Medical Records Licensing Medicare Medicare 52

MedTrainer

OCTOBER 16, 2023

Anti-Kickback Statute The Office of Inspector General (OIG) is responsible for the enforcement of the Anti-Kickback Statute. The statute protects patients and federal healthcare programs from fraud and abuse. It prohibits transactions intended to influence the referral of federal healthcare program business.

Compliance 52

Compliance US Department of Health and Human Services HIPAA Medicaid 52

YouCompli

APRIL 13, 2022

But tactics common in other industries might be considered illegal beneficiary inducements in healthcare, especially for beneficiaries of federal programs like Medicare or Medicaid. However, some key words and phrases should at least pique the interest of a conscientious compliance officer. “Co-pay

Medicare 40

Medicare Medicare Governance Compliance 40

MedTrainer

JANUARY 26, 2024

Here are some common non-compliance activities: Failure to Maintain HIPAA Compliance: The Health Insurance Portability and Accountability Act (HIPAA) sets strict guidelines for safeguarding patient health information. Significant fines also can be levied by the Office of Inspector General (OIG) for overbilling Medicare and Medicaid.

Compliance 52

Compliance Informed Consent HIPAA Medical Billing 52

MedTrainer

NOVEMBER 6, 2023

A strong compliance plan is of great importance in healthcare due to the complex web of regulations, ethical considerations, and patient well-being at stake. Patient Harm: Inconsistent or inadequate compliance measures can result in suboptimal patient care, medical errors, and harm to patients.

Compliance 52

Compliance Fraud Nursing Homes Governance 52

MedTrainer

FEBRUARY 12, 2024

Legal Penalties: Healthcare non-compliance can result in legal penalties, including fines, civil lawsuits, or criminal charges, depending on the severity of the violation. For example, healthcare fraud or intentional non-compliance with regulations can lead to criminal charges.

Compliance 52

Compliance Licensing Governance Fraud 52

Health Care Performance

JULY 20, 2022

A New York ENT physician was convicted of filing false claims with Medicare and Medicaid. The physician submitted claims totaling about $585,000 to Medicare and Medicaid and was paid roughly $191,000. Mole billing fraud scheme totals $4.1 Fraudulent documentation was submitted in response to Medicare audits.

Fraud 52

Fraud Compliance Medicaid Medicaid 52

MedTrainer

AUGUST 30, 2023

Medicare Advantage (Part C). Medicare Advantage plans are managed care plans offered by private insurance companies as an alternative to traditional Medicare (Parts A and B). Medicaid Managed Care. These plans follow managed care principles to control costs and improve care coordination for Medicaid recipients.

Compliance 52

Compliance Regulatory Compliance Medicaid Medicaid 52